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Coverage of and Influences on Timely Administration of Hepatitis B Vaccine Birth Dose in Remote Rural Areas of the People’s Republic of China

A survey was conducted in 2006 to assess the coverage and timeliness of the birth dose of hepatitis B vaccine (HepB₁) and related influences among children in rural areas of Guangxi, Guizhou, Tibet, and Shaanxi provinces, People’s Republic of China. A total of 3,390 children born in 2004 were surveyed in four counties in each province, where a project to strengthen routine immunization is being implemented by the China Ministry of Health, supported by the United National Children’s Fund. Two-stage stratified cluster sampling was undertaken to select those surveyed. A questionnaire was administered to parents or guardians and vaccination records were assessed. HepB₁ administration was timely for 31.6% of the sample. Timeliness of HepB₁ for children delivered at home (13%) was lower than for children born at county-level or higher facilities (54%) (odds ratio [OR] = 6.52, (95% confidence interval [CI] = 5.29–8.04, P < 10 ^–3), at township hospitals (49%, OR = 7.14, 95% CI = 5.68–8.98, P < 10 ^–3), or private clinics (59%, OR = 5.64, 95% CI = 3.68–8.64, P < 10 ^–3). Children of Tibetan (24.8%, OR = 0.16, 95% CI = 0.12–0.21, P < 10 ^–4), Zhuang (27.8%, OR = 0.73, 95% CI = 0.57–0.94, P < 0.02) or Meng, Miao, and Hui ethnicity (14.2%, OR = 0.36, 95% CI = 0.29–0.45, P < 10 ^–4) were less likely than children of Han ethnicity (33.2%) to have received a timely birth dose. Children lacking vaccination registration cards (OR = 0.64, 95% CI = 0.51–0.80, P < 10 ^–4) and children whose parents or guardians did not know the importance of timely HepB immunization (OR = 0.62, 95% CI = 0.46–0.84, P < 10 ^–2) were also less likely to have received a timely birth dose. Parental knowledge and prioritization of birth-dosing was low among children who did not receive it. The timeliness of HepB₁ should improve with increasing rates of hospital delivery, training of birth attendants, increasing staff and community awareness of the importance of the birth dose, and by focusing on vulnerable groups.

Received May 5, 2009. Accepted for publication July 16, 2009.

Acknowledgments: We thank the staff in the four project provinces and 16 counties for their support during the survey.

Financial support: This study was supported by UNICEF.

^* Address correspondence to Huaqing Wang, Department of National Immunization Program, China Center for Disease Control and Prevention, Beijing, People’s Republic of China. E-mail: susanz6{at}hotmail.com

Authors’ addresses: Yuqing Zhou, Huaqing Wang, Jingshan Zheng, and Wei Xia, Department of National Immunization Program, China Center for Disease Control and Prevention, Beijing, People’s Republic of China. Xu Zhu and David B. Hipgrave, Department of Nutrition and Health, United Nations Children’s Fund, China Country Office, Beijing, People’s Republic of China.